Cardiac Anomalies - is something going on or is this normal?

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I used to race at a high level back in the early 90's. I was pretty much useless when it came to reading a race, but I trained more than pretty much everyone else and could drop top ranked riders in training rides of 150 km's and more. Fast forward to a couple years ago when I went to see a heart specialist because pretty much everyone of any age was passing me while on a ride to the friggin corner shop. Turns out I was gasping for breath because my heart rate exceeded 300 beats per minute. I would literally faint when taking my dogs for a walk. After seeing three specialists over the course of a year, I was told my condition was a result of excessive training when riding. I am now well past the age of racing bikes, but I am told that the combination of riding in previous years and current alcohol use is the cause of my condition. Drinking has replaced riding, but I always use the training thing as an excuse for the reason I can no longer exercise and do strenuous activities. p.s. The last part was an attempt at a joke.
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Aug 13, 2016
Goeleven, Goolaerts, Myngheer, De Greef, Vanacker, Verdick, Nolf, Duquennoy, De Vriendt. Seems like Belgian/Dutch riders/teams are way overrepresented in cardiac-related fatalities of youngish riders in these last few years - they're pretty much all of them. Is it because we're not hearing about young Spaniard/Italian/French/American/Eastern European/Colombian/etc riders deaths at this conti/proconti/amateur level? Is there a difference in pre sport check ups and screening? Is it randomness?

FWIW, I remember reading the authopsy showed Larsen's cause of death wasn't cardiac.
Difficult to say what is going on in Belgium & Netherlands with the death of young riders. Is it simply they get reported and there is half a dozen young cyclists deaths each decade in all countries too, but we don't hear about them in cycling press perhaps? Can't believe with social media today, this wouldn't hit most cycling press in each country. UK figures in young people (14-35) shows 12 deaths per week from undiagnosed heart conditions. Niels De Vriendt I read, was said to have had a cardiac screening 2 weeks ago, but what tests I don't know. There are generic tests like ECG & Echo, then there are more involved exercise-based ECG & Echo that can find conditions not found in more basic tests and several more specific tests too.
Here's one we haven't seen before (I think): Serge Pauwels (36, CCC) retires having been sidelined with myocarditis (an inflammation of the heart muscles). He's not strictly retired because of the myocarditis - you tend to recover from that - and his age and the lack of a future for CCC are the real issues here. That said, myocarditis is something we can probably expect to see more of in the months to come, it having become something of a talking point in American college sport as a consequence of Covid:
Daniels said that cardiac M.R.I.s, an expensive and sparingly used tool, revealed an alarmingly high rate of myocarditis — heart inflammation that can lead to cardiac arrest with exertion — among college athletes who had recovered from the coronavirus.

The survey found myocarditis in close to 15 percent of athletes who had the virus, almost all of whom experienced mild or no symptoms, Daniels added, perhaps shedding more light on the uncertainties about the short- and long-term effects the virus may have on athletes.
In Pauwels case, there is apparently no linkage with Covid and his myocarditis had other causes.

(Caveat: there is, as is to be expected, some dispute over whether there is a link between Covid and myocarditis in the first place, and the severity of such a link in the second. Cynically, however, college sport needs to take any link seriously, even if only for the sake of the no claims bonus on their insurance policies.)
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Diego Ulissi (31, UAE), sidelined with myocarditis:
“Diego underwent the normal health checks required by the UCI and the team. Subjectively he was fine and did not feel any disturbance, but the finding of an irregular heartbeat during a physical exertion, not previously present, gave us some doubt,” said team doctor Michele De Grandi. "Even with a normal ultrasound appearance, two new tests (Holter ECG 24 hours, which highlighted further arrhythmias, and a cardiac MRI scan) have drawn a conclusion of myocarditis. Myocarditis is an inflammation of the myocardial tissue, the heart muscle, usually of viral origin. As a precaution, Ulissi will undergo a period of absolute rest for a few months, during which he will carry out in-depth investigations to further clarify the clinical picture.”
Edit - comment from Ulissi:
"The doctors will do further examinations to understand the cause but we can exclude the coronavirus: I've done several blood tests and I haven't developed the antibodies. I'll do more tests in January but with the right care and attention. I still feel i'm an athlete. If I can, I'll be back racing with more determination than ever. However the future seems out of view and I want to focus on the present. I'm going to spend the holidays with my family."
In addition to Pauwels (see above), Romain Zingle (28, 2015) was also diagnosed with myocarditis. Neither Pauwels nor Zingle returned to racing.
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Is myocarditis worth noting here?
Short answer? Yes.

This is a thread about cardiac conditions in cyclists. It does not seek to ascribe causes and it certainly does not seek to blame doping. It asks a question, and - over time - presents evidence that may help answer that question, or (more likely) demonstrate why an answer is not as simple and straightforward as those for whom doping is the be all and end all of sport would like us to believe.

If we start excluding conditions because they don't appear to fit a doping narrative what does that achieve? Aren't we then entering into a world of fitting the evidence to the crime, a world of confirmation bias? And how do we choose the conditions to include or exclude? Should the PFOs already listed be delisted, as well as the cases of myocarditis?

Specifically WRT to myocarditis, is it not true that diuretics have been listed among possible causes of the condition? And is it not also true that undiagnosed myocarditis is thought to the the cause of some proportion of sudden cardiac-related deaths in sportspeople? As we don't tend to get autopsy reports on cardiac-related deaths is it wise to simply say one possible cause should be on the list of conditions of which we should not speak?
Patrick Bevin (28, CCC) out of Tour Down Under with cardiac arrhythmia.

Team doc Max Testa:
We had a relatively young, 26 yo die during a crit of some heart failure, 10 years back. He had been recently married and his widow was not disposed to pursue it in depth but he had no history of PED use and had been racing for 3 years. It had me backtracking to other athletes in the neighborhood that dealt with irregular pulse rates or quit. The affected profile was all over the map including a known doper with arrhythmia in his 40's, my brother/runner (non-doper) who overtrained and was diagnosed in his early 30's and has been treated twice, my Son's mother-in law who is very active and post menopausal along with here husband who was/is neither active nor menopausal (he can be overdramatic if that counts). The age groups, genetics and activity levels are inconsistent and would lead me to the uninformed conclusion that many more people died from it over time and it wasn't researched.
IMO that suggests exams for heart anomalies be required at least for NCAA collegiate level sports where schools have medical programs. Lord knows NCAA could make that happen and the data would be valuable. Wait....did I suggest the NCAA would do something that benefits athletes? Sorry.
Several arrhythmia cases in my club, certainly not doping-related afaikt, just seems part of being human and extreme endurance perhaps exacerbates it. Although I think the awareness of it means its tested for. Some were also diagnosed with it during sports science trials they needed medicals for. They didn't know they had it until then.
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Elia Viviani (31, Cofidis):
The Italian noted an anomaly in his heart rate while training on Sunday, and he contacted his former Liquigas team doctor Roberto Corsetti, a specialist in cardiology and sports medicine. Corsetti in turn referred Viviani to the Ospedali Riuniti in Ancona. Viviani was assessed there by Professor Antonio Dello Russo, who treated Mario Cipollini for a myocardial bridge in late 2019.
This one I missed in October: Viviani's Cofidis team-mate Fernando Barceló (25) suffered a tachycardia episode during the fifth stage of the Vuelta (Huesca to Sabiñánigo), his heart hitting 230 bpm. Following his withdrawal from the race surgery to resolve an issue with a vein in his heart was recommended and carried out.

Much to my regret tomorrow I will not start in @lavuelta According to the team doctor, I have to do some medical tests to rule out any heart problems after suffering a tachycardia today in competition Good luck to the boys of @TeamCOFIDIS in what remains
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